Vasopressors are commonly administered to patients in ICU to avoid hypotension associated with myocardial injury, kidney injury and death.
They may reduce blood flow in vasoconstricted vascular beds and are associated with cardiac, metabolic, microbiome, and immune function effects.
Balancing risks of hypotension risks from vasopressors is a major concern when managing patients.
Goal is to reach critical organ perfusion pressure:
Brain:mean arterial pressure (MAP) of 50 mmHg.
Heart: MAP of 65 mmHg
Kidneys: MAP 65-75 mmHg
IV Vasopressor have not been shown to be unsafe when used peripherally.
Dobutamine 3-5 mcg/kg/min 5-15 mcg/kg/min.
Dopamine 2 mcg/kg/min 20-50 mcg/kg/min
Epinepherine 0.1-1 mcg/kg/min
Norepinephrine 0.2 mcg/kg/min.
Milrinone 50 mcg/kg x 10 min
Phenylephrine 100-180 mcg/min then 40-60 mcg/min 0.4-9 mcg/kg/min
Vasopressin Fixed Dose 0.4 U/min
Methylene blue IV bolus 2 mg/kg over 15 min 1-2 mg/kg/hour
Effect on mortality at 90 days of reducing the exposure to vasopressors through permissive hypotension with a mean arterial pressure target of 60-65 mm Hg in intensive care unit (ICU) patients aged 65 years or older receiving vasopressors for vasodilatory hypotension: treatment with permissive hypotension resulted in death at 90 days among 41.0% of patients compared with 43.8% of those receiving usual care, a difference that was not statistically significant.
Reducing the exposure to vasopressors through permissive hypotension did not significantly reduce mortality at 90 days.
Among patients 65 years or older receiving vasopressors for vasodilatory hypotension, permissive hypotension compared with usual care did not result in a statistically significant reduction in mortality at 90 days.